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*Daquan* states: Heart pain during pregnancy is caused by the entanglement of wind pathogen and phlegm-fluid, damaging the collateral branches of the heart, resulting in pain that comes and goes. If the *Zizang* (uterus) is injured, it leads to fetal movement and vaginal bleeding.

Shenzhen's commentary: The above paragraph describes the syndrome of heart pain occurring before delivery. Persistent heart pain due to wind pathogen and phlegm-fluid belongs to excess syndromes caused by external contraction. However, deficiency of heart qi and blood insufficiency during pregnancy are also sufficient to cause this condition. The discussion in *Daquan* only mentions one aspect.

*Daquan* states: The Kidney governs the waist and feet. Due to strain and injury affecting the meridians, when deficiency occurs, wind-cold pathogens take advantage. Persistent lower back pain often disturbs the fetal qi. In women, the Kidney connects to the uterus via the uterine ligaments (*Baoxi*). Lower back pain during pregnancy, if severe, can lead to miscarriage. Therefore, lower back pain during pregnancy is of utmost importance. For lower back pain caused by sprain or strain with stagnant qi, use *Tongqi San*. For cases due to Kidney deficiency, use *Qing'e Bulao Wan*. The general principle is to prioritize securing the fetus.

Wang Shishan said: A woman at eight months of pregnancy suffered from lower back pain, unable to turn or lie on her side, accompanied by dry and constipated stool. The physician administered tonifying agents such as Ginseng, which exacerbated the pain. Then, purgatives containing Nitre (Xiaoshi) and Rhubarb (Dahuang) were used; although the constipation was relieved, the pain remained unchanged. Upon examination, the pulse was slightly surging and rapid. He stated: This is heat in the blood combined with blood stasis. It is appropriate to use *Siwu Tang* added with Costus Root (Muxiang), Frankincense (Ruxiang), Myrrh (Moyao), Phellodendron Bark (Huangbai), and Hemp Seed (Huomaren). After five doses, the pain decreased, and the stool became moist. Subsequently, fever, red face, and occasional aversion to cold appeared. The previous formula had Frankincense and Myrrh removed, and Bupleurum Root (Chaihu) and Scutellaria Root (Huangqin) were added. After two doses, the alternating chills and fever subsided, but the lower back pain recurred. This indicated that the blood circulation had been restored. Ginseng was added to the previous formula, after which the condition stabilized.

He Song'an said: The waist is the mansion of the Kidney, where the Qi and Blood of the Foot-Shaoyin Kidney Meridian accumulate and flow. Lower back pain during pregnancy mostly belongs to labor-induced causes. Since the uterus is connected to the Kidney, heavy lifting and overexertion injure the uterine ligaments, causing inevitable lower back pain. In severe cases, the uterine ligaments may detach, often leading to spontaneous abortion. Treatment should prioritize calming the fetus; once the fetus is secure, the pain will heal itself. If a woman who usually enjoys comfort suffers from lower back pain, it must be due to unregulated sexual intercourse injuring the uterine ligaments. If the pulse is slow, and pain worsens on cloudy days or after prolonged sitting, it is damp-heat. If the waist feels heavy as if bound by objects and cold, it is cold-dampness. If the pulse is large and pain persists, it is Kidney deficiency. If the pulse is choppy and pain is lighter during the day and heavier at night, it is stagnation of Qi and Blood. If the pulse is floating, it is invasion by wind pathogen. If the pulse is excess, it is due to sprain or trauma. If lower back pain occurs near term, it indicates the descent of the uterus and loosening of the Kidney Qi, signaling imminent childbirth.